Confidential Counselling Referral Form 2026

1. Click ‘Get Form’ to open the Confidential Counselling Referral Form in the editor.
2. Begin by entering the young person’s name and date of birth/gender in the designated fields. This information is crucial for identification purposes.
3. Fill in the contact details, including mobile number, home number, and email address. Ensure accuracy for effective communication.
4. Indicate the date of referral and the worker completing the referral. This helps track the referral process.
5. Select the school or college attended by circling the appropriate option provided.
6. Respond to consent questions regarding leaving messages and identifying yourself to parents or guardians by circling 'Yes' or 'No'.
7. Provide details about who referred you for counselling, including their name and organization if applicable.
8. Choose your preferred counsellor's gender by selecting either female, male, or no preference.
9. Specify your preferred location for counselling sessions along with available days and times.
10. If you are receiving support from another professional, provide their details and indicate whether we can contact them.
11. In case of an emergency during counselling, provide a contact person's name, relationship, address, and phone number.
12. Lastly, enter your GP's contact details to ensure comprehensive care coordination.

Start filling out your Confidential Counselling Referral Form today on our platform for free!